Short Project Description (less than 50 words):
The Four A’s Syringe Access Program (FASAP) provides clean syringes and supplies to injection drug users to reduce the spread of HIV and Hepatitis C in this high risk population. FASAP also disposes of used syringes, reducing the presence of potentially contaminated syringes in Alaska.

The Big Why (less than 300 words):
As heroin abuse skyrockets nationally, community members are scrambling to respond to this complicated epidemic. The program sees an average of 86 new participants each month, on top of the ever growing base of regular users. This fiscal year, FASAP has served individuals from 82 distinct Alaskan communities, from Adak to Noatak to Ketchikan. In FY16, the program distributed 479,177 syringes, which is more than double than we distributed in FY14. The program disposed of 493,933 syringes, meaning more syringes were collected than distributed. Heroin and meth abuse is affecting Alaskans more than ever before.
FASAP is uniquely positioned to engage with active injection drug users who often do not seek regular access to medical care or testing. Not only is the program reducing the number of HIV and Hepatitis C infections by educating on harm reduction practices, but they are also able to intervene in dangerous health conditions. Often, participants in FASAP will ask for advice on abscesses, wound care or other conditions that can be related to serious infections. The cost to the public health system is reduced by intervening before emergency services are necessary. Four A’s, non-judgmental staff is also available to make tailored referrals to treatment, detox and other necessary services to help lift participants out of drug addiction.

If Center for Disease Control projections hold true for Alaska, 675 of the 1,125 Hepatitis C cases in Alaska in 2014 were due to needle sharing. One 3 month treatment for Hepatitis C costs more than $81,000 through Medicaid, which means if FASAP prevents just once case of Hepatitis C, the cost savings will have paid for almost our whole FASAP program.The Bottom Line: (how much, less than 100 words)
Funding for syringe access is incredibly limited, given a federal ban on funding for supplies and the Alaska fiscal crisis. A few small foundations support this crucial work, but the funds are not enough to answer the demand. $3,000 would provide approximately 28,000 syringes and corresponding supplies, or about 2 weeks’ worth of supplies for our Anchorage and Juneau locations. Sustaining necessary supplies keeps the spread of Hepatitis C and HIV in our community in check, and makes us all healthier. Having a safe place that incentivizes the return of used syringes means less needle-stick threat to other community members.

Client Stories:
Delilah first came in to FASAP last summer. She was reserved and rarely spoke with anyone, eagerly getting her syringes and rushing to “get back to work.” Little by little the relationship between Delilah and staff grew as she gained more confidence in the education she was being provided. She didn’t want to get off drugs but she did want the wounds on her legs to heal and for the intense swelling to go down. After advice from FASAP staff, over time her wounds healed. Winter came and Elizabeth didn’t look very good -her skin was pale and she had lost a lot of weight. Staff was concerned that she had a blood infection and urged her to seek medical care. It was two months before Elizabeth was seen again, as she had gone to the hospital and received treatment for endocarditis, a heart infection. Upon returning, she looked much healthier. “I want off of these drugs, I was off for two months in the hospital, but I am back to using. I can’t keep doing this.” Staff asked her if she had ever considered replacement therapy, which began a 30 minute conversation spent discussing her options. Elizabeth came into the exchange last week, just to pick up condoms. “I’ve been on methadone for a month and a half now, I haven’t been shooting up.”

During one of his visits to the Four A’s syringe exchange, Joshua said he wanted to thank us. Joshua said, “Thanks to the Four A’s syringe exchange, I was able to get and use only clean needles during the nine months that I waited for my treatment program. When I was finally called in to begin the program, I got my HIV and Hep C rapid tests done at the Four A’s office. I give full credit to the syringe exchange for keeping me free from both diseases. So many of the injection drug users in my community have Hep C and are at risk for HIV, but because of the clean needles I received at the exchange I didn’t have to share needles with them. Being able to enter recovery free from both diseases is a huge deal because I know once I finish my treatment, I will have a new lease on life. I encourage all my friends to get tested at the syringe exchange, because you provide services in a non-judgmental and supportive manner so we feel safe and comfortable here.”

“Thank you guys so much for what you do. The lady who sits up front (Rebecca, HIV Prevention Coordinator) referred me to grief counseling because of my parent’s death. I’ve been going and it’s been working out really well. Today, I’m happy and I haven’t even used! These needles are just for back up. You guys truly make a difference with what you do. Thank you so much.”

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